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ACCESSION NO: 1016336 SUBFILE: CRIS
PROJ NO: NM.W-2018-01897 AGENCY: NIFA NM.W
PROJ TYPE: OTHER GRANTS PROJ STATUS: TERMINATED
CONTRACT/GRANT/AGREEMENT NO: 2018-33800-28395 PROPOSAL NO: 2018-01897
START: 01 SEP 2018 TERM: 31 AUG 2022 FY: 2021
GRANT AMT: $400,000 GRANT YR: 2018
AWARD TOTAL: $400,000
INITIAL AWARD YEAR: 2018

INVESTIGATOR: Caswell, L.

PERFORMING INSTITUTION:
PRESBYTERIAN HEALTHCARE SERVICES
9521 SAN MATEO BLVD NE
ALBUQUERQUE, NEW MEXICO 87113

CONNECTING HARVEST TO HEALTH/CONECTANDO COSECHAS CON LA SALUD

NON-TECHNICAL SUMMARY: Bernalillo County is New Mexico's most populous county (662,564 residents, one-third of the state population) and it contains the state's largest city, Albuquerque (population 545,852). The county has socio-geographic contrasts in extreme poverty and wealth, areas with abundant groceries and food deserts, cutting-edge medical facilities and federally designated healthcare shortage areas, neighborhoods peppered with advanced degree professionals and others where having as much as a high school diploma puts one in the minority. When it comes to health, life expectancy varies by more than 22 years across census tracts within Bernalillo CountyPartners, Presbyterian Healthcare Services (applicant and backbone agency), Three Sisters Kitchen, Encuentro, and Meals on Wheels Albuquerque will bring a comprehensive approach to Community Food Projects by connecting elderly residents with local produce, nutritious meals, and support in preparing and enjoying healthy foods. Those connections will be created by Home Health Aides (HHAs) who have supplemental nutrition/cooking training, medical providers assessing needs of elderly patients, and via home meal delivery service. Connecting Harvest to Health/Conectando Cosechas con la Salud will improve senior nutrition, reduce language access disparities, increase local food access, increase consumption of nutritious foods, enhance workforce development, support entrepreneurship, and strengthen the support structures for agricultural producers. The project will train 135 HHAs (most Spanish speaking or bilingual), support purchase of over 63,000 pounds of produce from 10+ local growers, and provide meal delivery to 540 low-income seniors. Overall, 1,620 seniors and will directly benefit from HHA and Meals on Wheels program services during the four-year project period.

OBJECTIVES: GOAL 1: Improve food security and nutritious eating among seniors. Outcomes: (1.1) Within four years, train 135 HHAs on senior eating assessment, general, and geriatric nutrition. (1.2) Beginning in year 2, HHAs will annually assess food security 1,080 senior clients (including food benefits eligibility and enrollment navigation). (1.3) Connect 1,620 seniors in Bernalillo County with free nutritious meals through HHA and Meals on Wheels programming over project period. (1.4) In years 2-4, 95% of HHA graduates report incorporating preparation of nutritious, diet-appropriate meals in client care six months following program completion (pre-prepare, on-site cooking, supporting client cooking).GOAL 2: Improve food security and nutrition among Home Health Aides. Outcomes: (2.1) Through training program, 100% of program HHAs aware of their own eligibility for SNAP and eligible low-income HHAs enroll during training. (2.2) 90% of HHA graduates report increased personal healthy eating behaviors (produce shopping, healthy cooking, nutritious meal consumption, etc.) at six months post-graduation. (2.3) Achieve at 20%+ reduction in HHAs reporting food insecurity between training start and completion, per standard food insecurity screening questions.GOAL 3: Increase purchase and use of local food in senior meal preparation. Outcomes: (3.1) Within four years, train 135 HHAs on healthy cooking using local produce to prepare health meals for their households and to meet client needs. (3.2) 10+ growers supply local produce for meal preparation, cooking classes, and Meals on Wheels during project period. (3.3) At time of training program completion, 100% of HHAs know how to use supportive food programs like SNAP, farmers market match dollar programs, subsidized CSA, and Meals on Wheels. (3.4) Meals on Wheels increases local food sourcing and incorporation in delivered meals by 20,250 pounds per year in Years 2-4.GOAL 4: Increase purchase and use of local food by HHAs. Outcomes: (4.1) Through training program, 100% of program HHAs aware of their own eligibility for SNAP and local benefits/incentives to buy produce for themselves and their families, eligible low-income HHAs better use existing food programs including SNAP. (4.2) In years 2-4, 75% of HHA program graduates report sourcing local produce for client meals and/or aiding clients in buying/accessing local produce within the 6 months following program graduation. (4.3) In years 2-4, 80% of HHAs report buying local produce, meat, eggs, or dairy within the 6 months following program graduation.GOAL 5: Grow income opportunities for HHAs by providing specialized food and nutrition education. Outcomes: (5.1) 100% of local home health agencies employers aware of HHA training program and benefits of hiring graduates. (5.2) 100% of HHA training graduates using EnCasa Care Connections have nutrition program included in profile. (5.3) 25% of HHAs work with Three Sisters Kitchen and Encuentro to identify income opportunities using specialized skills. (5.4) 50% of HHAs self-report earning $10+ per hour six months following program completion (a rate above typical entry wages and near median wages).7GOAL 6: Cultivate a home health workforce that is highly trained in understanding senior food and nutrition needs and evidence-based strategies for senior care. Outcomes: (6.1) Place 10 graduates per cohort (90 total) in one-month paid and mentored home health internships to practice nutrition and food security assessment, dietary needs, cooking and food preparation, social meal accompaniment and general home health aide skills. (6.2) HHAs, community members, seniors, and partners take part in 16 quarterly Advisory Committee Meetings about program progress, training needs, unmet senior needs, quality improvements, and strengthening referral and sector connections. (6.3) HHAs participate in 16 quarterly food and nutrition continuing professional development workshops during project period. (6.4) Via train-the-trainer initiative, HHA graduates advise, teach, and help grow the program in years 3 and 4.

APPROACH: Project Set-Up, Coordination, and Monitoring. During start-up, partners will set up sub-award MOUs; recruit members of the Advisory Committee (community members, HHAs, partner staff and other stakeholders); hire and train staff; and prepare grants and program management systems. Training will be coordinated by Encuentro and Three Sisters Kitchen, with content expertise provided by Presbyterian and Meals on Wheels. Presbyterian will coordinate the scale up of Meals on Wheels local produce buying. Presbyterian will also manage the financial aspects, perform reporting, provide evaluation staff, and manage the overall project as a backbone agency. As detailed in Section E, program formative and summative evaluation will include quarterly Advisory Committee meetings, client and HHA surveys and assessments, annual cycles of improvement, and ongoing community engagement.Leadership Development and Training. Project partners will pilot and scale a Home Health Aide Food & Nutrition training program to supplement the HHA certification training program offered by Encuentro. Training will last 10 weeks/units (30 hours instruction) with the option of a paid month-long internship following program completion. The program will be held at Three Sisters Kitchen and will combine instruction, cooking classes, and meal preparation. Topics will include food safety, strategies to reduce food insecurity, nutrition deficiencies and health effects, non-compliance to special dietary needs, common problems with food and drug interactions, the benefits of mealtime accompaniment/socialization, food consumption issues (meal texture for chewing/swallowing challenges and assistance devices for those who struggle with utensil handling). Skills development will include client assessment and screening, preparation of local produce, cooking for dietary needs, creating special texture meals, creating off-site prepared meals for clients, and sourcing local produce. Initial cohorts will be Spanish and bilingual, with English curriculum developed and English language cohorts starting in Year 3. Program graduates will be able to further develop their skills through a month-long paid internship and 16 ongoing continuing education and professional development workshops. Internships participants will work in client homes three hours per day, three days per week, for one month. These visits will include food security and dietary needs screening, referral to federally- and locally-funded nutrition supports, meal preparation and mealtime accompaniment, and general home health service. The paid internship will be offered at no cost for the family - allowing them to try out home care with a certified HHA who has supplemental food and nutrition training. Encuentro staff and HHA peer mentors will check in with interns and offer guidance and support and listen to client concerns, needs, and input. Continuing education workshops will be held quarterly and cover deeper knowledge on specific nutrition needs, client supports, and skills and address needs found through community and stakeholder engagement and evaluation.Food and Nutrition. The HHA training is about knowledge in action: using training to prepare nutritious meals meeting client dietary needs in client kitchens and at Three Sisters Kitchen. During training, HHAs will explore ways to increase nutritive value of meals and incorporate local produce. Meal preparation will include cooking meals in client home, supporting clients and families who cook themselves, making ready to eat meals at Three Sisters Kitchen, and prepping local produce at Three Sisters Kitchen so it is ready to eat or use as ingredients in meals. The cohorts moving through HHA training are projected to prepare more than 87,000 meals during the four-year project period.8 Another strategy of Connecting Harvest to Health is expansion of Meals on Wheels' home delivery meal service through referrals and sponsorship of meals. Meals on Wheels is a critical support in the county as it does not have age, income, or health eligibility requirements and offers both long-term and short-term services that meet a variety of dietary and texture needs. Presbyterian will sponsor meal service lasting one to three months for high-risk, low-income patients referred by hospital, clinic, and home health medical staff (for example seniors recovering from surgery). This will be free of charge to clients.Strengthening Food Systems. The cooking and meal preparation training at Three Sisters Kitchen will focus on use of locally grown produce sourced from area farms, a feature that will include significant direct purchase of local food, exposure to local food, improved knowledge on preparing local and seasonal foods, and techniques for season extension of harvests. HHAs will learn about sites and sources for local food such as CSAs, growers' markets, mobile market, area stores carrying local produce, etc. Presbyterian will work with Meals on Wheels to institutionalize regular sourcing of local produce for their general meal preparation to increase the proportion of locally sourced ingredients. Currently, Meals on Wheels buys local produce on a retail basis when donated funds allow. Presbyterian will help transition Meals on Wheels to bulk, wholesale purchasing; create linkages with Agri-Cultura and local farmers; and plan produce needs in advance in order to enter into pre-season purchase agreements (allowing farmers to plan their crops better, knowing they have a secured buyer). In total, these strategies will result in an predicted purchase of over 63,000 pounds of local produce over four years.Economic Development. The existing HHA program is a career development initiative for community members. The Food and Nutrition training will serve client needs better while enhancing employability and wage potential for HHAs. The existing HHA program teaches students about running a small business, working as an independent contractor, and employee rights for those working for home care agencies. Self- employed graduates are supported through Encuentro's EnCasa Care Connections, an online matching registry where persons seeking caregiver services in the home receive personalized help and are connected with HHA graduate candidates. Like existing training, proposed training will be offered to care workers free of charge and stipends will be included for participation in quarterly meetings and as program mentors and educators. HHAs are paid for internships, allowing them to earn wages while honing their food and nutrition skillset. As a hub for food entrepreneurship, Three Sisters Kitchen will nurture HHA food entrepreneurship, such as Aides seeking to prepare meals for a larger client base than their own. Three Sisters Kitchen can also link Aides with general food entrepreneur clients who may have good Value-Added Products for HHAs and their clients or be willing to collaborate on a joint food enterprise.

PROGRESS: 2018/09 TO 2022/08
Target Audience:Conectando Cosechas con las Salud/Connecting Harvest to Health (H2H) target audiences are Home Health Aides (HHAs) who are mostly Spanish speaking, or bilingual, and their families, local growers, low-income seniors, and seniors who are supported by HHAs.Most of these audiences reside in the South Valley in Albuquerque, New Mexico. Changes/Problems:The biggest challenge in years 1-4 of the project was the COVID-19 pandemic. This forced all in-person activities to pivot to a virtual platform which include, H2H cohorts, quarterly professional development workshops, advisory committee meetings, lead team meetings, cooking classes, etc. The Encuentro and Three Sisters Kitchen staff were able to design and implement online professional development workshops as well as the H2H HHA Program using the Zoom platform. Encuentro and Three Sisters Kitchen continued to utilize virtual tools and resources to support HHA learning. Some HHAs held back from participating in internships, and waited for in-person opportunities, as they report feeling overwhelmed by digital communications; find that online learning is not a good match; or do not have access to technology and internet services. Some Home Health Aides were unable to finish the internship as one of the clients died, one was transferred to a group home, and one of the HHAs left for personal reasons. As COVID-19 regulations in the state have shifted, our partners have slowly begun to re-integrate hands-on activities such as visiting the Downtown Growers' Market and local farms. The worsening economic crisis has created more stress on local and national food systems. Meals on Wheels found that it was more difficult to obtain produce from their usual supplies but shifting from wholesale purchasing to use and purchase of local products has alleviated some of this burden. Although, the winter months reflect reduced use of local produce and local products following harvest season. This has also caused a strain on food budgets for program participants and graduates. This reflects the greater need for larger investment in food by program and federal partners. The final year of the grant emphasized working with partners, HHAs, community members, and Presbyterian leadership to develop a long-term sustainability plan and funding for the Harvest to Health program. What opportunities for training and professional development has the project provided?Ninety-eight (98) Home Health Aides were trained in Years 1-4. Additionally, 55 Home Health Aides participated in a one-month paid internship through the H2H Program. Encuentro hosted quarterly professional development workshops and leadership trainings; 14 professional development workshops were completed in Years 1-4. Three Sisters Kitchen and Encuentro partnered with experts to develop Spanish-language Nutrition and home cooking videos. These videos covered: Introduction to the Healthy Eating Plate, reading nutrition labels, portion size, diabetes, the Diabetes My Plate, Heart Healthy Diet, caring for clients with dementia, tube feeding, Narcan training, and an introduction to a local farm. Our partners launched a home gardening program for Harvest to Health graduates in response to the interest and need expressed by participants. Seventeen (17) program graduates received covered raised beds at their homes and participated in Spanish-language gardening classes. A new internship supported the gardening program in coordination, community building, and development of responsive learning opportunities and created a learning and leadership opportunity for an H2H graduate. Three Sisters Kitchen also initiated a new collaboration with the University of New Mexico's Occupational Therapy M.S. program. Two (2) graduate students, under close supervision by their professor, developed content to support training in assisting clients facing challenges with chewing,swallowing, and mobility. While utilizing a web-based curriculum is very accessible and can facilitate meaningful engagement with content, an exclusively online environment remained challenging. Despite challenges, program participants (students, facilitators, and presenters) report a strengthening in technological skillset. Program educators upgraded their processes for managing logistics, including delivery of educational materials, surveying, and organizing virtual small out-of-class working groups. Via the Train-the-Trainer model, 6 HHAs facilitated Spanish-language Cooking Matters curriculum at Presbyterian sites and 5 participants developed and taught Spanish-language workshops at Senior Centers. Lastly, Three Sisters Kitchen created a second paid internship opportunity for an H2H graduate to manage coordination between the Harvest to Health and ReFresh fresh food access program. The intern improved communication with H2H participants in the program, supported participation in the cooking classes, and recommended program enhancements informed by her experience as a Home Health Aide. How have the results been disseminated to communities of interest?Encuentro and Three Sisters Kitchen have promoted the success of the program and the graduates via social media, internal and external networks, additional funders, and the senior community. They have also shared the success with all HHAs attending Central New Mexico Community College to gain additional interest from new HHAs to participate in the program. Meal on Wheels promoted the internship program and the success of graduates to their clients to encourage clients to participate in having a Home Health Aide intern in their homes. Presbyterian Healthcare Services shares the results internally with the health system and health plan through various committees and dashboards. At Quarterly Advisory Team meetings, partners share accomplishments, barriers, and ideas with the group. Annual evaluation reports were shared with partners and communities of interests for Years 1-3; the last and final Harvest to Health evaluation report is set to be released in the Fall of 2022. We have also completed a Harvest 2 Health infographic, highlighting the successes of the first two years of H2H. This was shared with partners, advisory meeting attendees, and Presbyterian leadership. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

IMPACT: 2018/09 TO 2022/08
What was accomplished under these goals? Conectando Cosechas con las Salud/Connecting Harvest to Health (H2H) project met or exceeded half of the goals set for Years 1-4 despite the onset of the COVID-19 pandemic during the project. The number of growers supplying local produce, number of seniors per year assessed for nutrition needs by Meals on Wheels, number of seniors connected with meals, and pounds of local produce purchased all met or exceeded grant total goals. Some goals were not met during the project either due to the circumstances created by COVID or other factors. Please see the challenges section for further explanation. The pre- and post- surveys and 6-month follow-up surveys for the HHAs remained the same as last year and did not include questions specifically tied to evaluation metrics. In some cases, a proxy question was used for analysis (resources for food vs SNAP benefits) and in others, the indicator could not be measured (salary rate of graduates). GOAL 1: Improve food security and nutritious eating among seniors (1.1) Ninety-eight (98) HHAs were certified during the project. This does not meet our total grant coal of 135 HHAs trained over 4 years. (1.2a) Meals on Wheels assessed 2,408 seniors for food insecurity and wellbeing during Years 1-4, exceeding the grant goal by 123%. (1.2b) HHAs assessed 65 senior clients for food insecurity and wellbeing in years 2-4. This did not meet the goal of 90 seniors assessed in years 2-4. (1.3a) 2,754 seniors were connected to meals, exceeding the goal of 1,620 seniors over four years, by 70%. (1.3b) Meals on Wheels provided 578,602 meals to seniors during years 1-4, which met 103% of the original goal, 561,600 seniors assessed over 4 years. (1.4) 86% of HHAs reported on their six-month follow-up survey that they incorporated nutritious, diet-appropriate meals in client care from year 2-4. GOAL 2: Improve food security and nutritious eating among Home Health Aides (2.1) Pre and post-training assessments were administered to HHAs to assess their change in knowledge, attitudes, and behaviors on several topics. Eighty three percent (83%) of HHAs said they had an increase in knowledge about nutrition services and resources that are available while 17% said they had no change in knowledge of nutrition resources currently available, which indicates success of increasing knowledge on the topic. (2.2) 100% of HHA graduates reported an increase of personal healthy eating behaviors six months post-graduation. This exceeded the goal of 90%. (2.3) HHAs were assessed on their food need using the food insecurity questions, there was a 10% increase of food need amongst HHAs during participation in the program. The goal is an average of 20% reduction between training start and completion over 4 years. (3.1) Ninety-eight (98) HHAs were certified during years 1-4. This does not meet our goal of 135 HHAs certified over four years. (3.2) Over four years, Meals on Wheels worked with 22 growers who supplied local produce for meal preparation for Meals on Wheels clients. This goal was exceeded. GOAL 3: Increase purchase and use of local food in senior meal preparation - met or exceeded all outcomes (3.3) Pre- and post-training assessments were administered to HHAs to assess their change in knowledge, attitudes, and behaviors on several topics. Eighty three percent (83%) of HHAs said they had an increase in knowledge about nutrition services and resources that are available while 17% said they had no change in knowledge of nutrition resources currently available, which indicates success of increasing knowledge on the topic. (3.4a) Meals on Wheels purchased 49,363 pounds of local food, which exceeds the program goal of 15,200 lbs of local produce over four years. (3.4b) During years 1-4, Three Sisters Kitchen purchased 3,892 pounds of produce, which is 170% of 2,288 pounds over 4 years goal. Total pounds of local produce purchased between the two organizations equaled 41,833 lbs. (3.5) The farmers survey was conducted by Presbyterian Healthcare Services with farmers who are part of the Agri-Cultura Network (a farm cooperative) and other local farms. 100% of the local growers reported a positive impact on the local agricultural system from the program. GOAL 4: Increase purchase and use of local foods by HHAs (4.1) Pre and post-training assessments were administered to HHAs to assess their change in knowledge, attitudes, and behaviors on several topics. Eighty-three percent (83%) of HHAs said they had an increase in knowledge about nutrition services and resources that are available while 17% said they had no change in knowledge of nutrition resources currently available, which indicates success of increasing knowledge on the topic. (4.2) Sixty-two-point two percent (62.2%) of HHA graduates reported sourcing local produce for client meals and/or aiding clients in buying/accessing local produce. (4.3) Sixty-two-point two percent (62.2%) of HHA graduates reported sourcing local produce for client meals and/or aiding clients in buying/accessing local produce GOAL 5: Grow income opportunities for HHAs by providing specialized food and nutrition education (5.1) One hundred percent (100%) of local HHA care recipients who participated in the HHA internship are aware of the HHA training program and benefits of hiring graduates. (5.2) Fifty-three-point four percent (53.4%) of HHA training graduate reported having nutrition program included in the EnCasa Care Connections profile. The EnCasa Care Connection system was being updated to allow HHAs to alter their profiles independently to include the nutrition program certification. This may have impacted the ability of HHAs to update their profiles prior to the time of survey. (5.3) Fifty-six-point-seven percent (56.7%) of HHA graduates reported that they have additional opportunities because of the training. (5.4) Fifty-six-point-seven percent (56.7%) of HHA graduates reported that they have additional opportunities because of the training. GOAL 6: Cultivate a Home Health workforce that is highly trained in understanding senior food and nutrition needs and evidenced-based strategies for senior care. (6.1a) Fifty-five (55) HHAs graduates completed the one-month internship in years 1-4. This does not meet our goal of 90 HHAs over 4 years. Various barriers such as COVID-19, family and personal obligations, and illness and death made it difficult for some HHA's to complete the internship. (6.1b) 1,980 HHA internship hours were completed in years 1-4. Although the goal wasn't met, we consider this successful because HHA interns were able to complete some internship hours, despite the continued barriers of COVID-19. (6.2) In total, Presbyterian Community Health held fifteen (15) Advisory Committee meetings over four years. This does not meet the goal of 16 meetings over four years. The last advisory meeting was set to be held after the completion of the grant. It was agreed upon by the lead meeting to make the 15th advisory meeting the final advisory meeting and celebration. (6.3) Encuentro held fourteen (14) professional development workshop over four years, which is just shy of the project goal of sixteen (16) professional development workshops. (6.4) In Year 3, partners assessed interest in peer teaching opportunitiesamong HHA graduates of the H2H program. From those assessments (surveys and conversations), Encuentro developed and delivered leadership development and facilitation training for HHAs in Year 4.In Year 4, 6HHAs facilitatedCooking Matters Classes at Las Estancias Clinic. Five (5) more graduates were trained in the Cooking Matters curriculum and will begin teaching community nutrition classes this fall. (7.1) Four reports to be compiled and analyzed were received from each of the partners in years 1-4. The final Year 4 report is set to be released on 10/1/2022. The goal will be met.

PUBLICATIONS (not previously reported): 2018/09 TO 2022/08
No publications reported this period.